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General NPI Number Information
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NPI Number | 1497625503
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Entity Type | Individual
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Provider Name | THAI YANG LPC-IT, SAC-IT
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Gender | Male
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Dates
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Enumeration Date | 11/05/2025
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2801 CALUMET DR
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City | SHEBOYGAN
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State | WI
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Zip | 53083-3839
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Country | US
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Telephone | 920-451-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 520 PINE RIDGE AVE
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City | HOWARDS GROVE
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State | WI
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Zip | 53083-2246
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Country | US
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Telephone | 920-242-7760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 21010-130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8782-226
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License Number State | WI
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